Abstract :
The use of lipid lowering drugs in hypercholesterolemic, hypertensive patients is often indicated. In patients with established coronary disease, the presence or absence of hypertension is irrelevant. All patients should be treated aggressively to lower LDL cholesterol below 100 mg/dL. Evidence of the benefit of cholesterol lowering in the secondary prevention of coronary disease is overwhelming. In patients with high LDL levels but without clinical coronary disease, the presence of hypertension plays a role in the selection of patients for drug therapy. In men under 35 and premenopausal women who have two other risk factors, one of which may be hypertension, drugs are introduced when the LDL cholesterol is over 190 mg/dL after diet. In women over age 55 and men over age 45, the LDL threshold is lowered to 160 mg/dL for those with any risk factors. Given the enhanced risk of coronary disease in those with other risk factors, these guidelines are quite conservative. Because both diuretics and some beta adrenergic blocking agents have adverse effects on lipoprotein levels, and because the coronary preventive benefits of antihypertensive treatment has been disappointing, patients with hypercholesterolemia should be considered candidates for other antihypertensive agents. In patients over 65, the value of blood pressure lowering has been clearly demonstrated in clinical trials. The value of cholesterol lowering, however, has not. A large clinical study, ALLHAT, is now recruiting hypertensive subjects who also have elevated LDL. In summary, there are ample data, and clear and conservative indications for the use of lipid lowering agents in hypertensive patients.
